Cyclosporine belongs to the groups of medications known as immunosuppressant agents. It is used to prevent the rejection of organ transplants and bone marrow transplants by suppressing the body's natural defence, the immune system. It is also used to treat rheumatoid arthritis, which is thought to be caused by the body's own immune system attacking the joints of the body.

Cyclosporine is also used to treat severe psoriasis when other treatments have not been effective. It has also been found helpful in the treatment of a kidney condition known as nephrotic syndrome.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose of cyclosporine varies according to weight and circumstances.

For solid organ transplants, the recommended dose is 10 mg to 15 mg per kilogram of body weight daily (in 2 divided doses) starting at least 12 hours before surgery. The dose usually stays the same for 1 or 2 weeks after the operation and then is reduced gradually by the doctor so that a particular level of the medication in the bloodstream is reached.

For bone marrow transplants, the oral form of the medication is usually given as a daily dose of 12.5 mg to 15 mg per kilogram of body weight in 2 divided doses. This dose is usually continued for 3 to 6 months and then decreased gradually until it is stopped, about one year after the operation.

For treatment of psoriasis, the recommended oral starting dose is 2.5 mg per kilogram of body weight per day in 2 divided doses. If no improvement is seen in one month, the doctor may increase the daily dose gradually. The daily dose of cyclosporine should not go above 5 mg per kilogram of body weight per day. If there is still no improvement after 6 weeks of treatment, the treatment should be stopped. If the psoriasis improves, the doctor may gradually decrease the dose. Psoriasis often returns once the medication is stopped, so the goal of treatment is usually to find the smallest dose that will be effective.

For treatment of rheumatoid arthritis, the recommended dose is 2.5 mg per kilogram of body weight per day in 2 divided doses for the first 6 weeks of treatment. If the desired improvement is not seen, the doctor may increase the dose gradually to a maximum of 5 mg per kilogram of body weight per day, as long as the medication is still well tolerated.

For nephrotic syndrome, the recommended starting dose is 3.5 mg per kilogram of body weight per day for adults and 4.2 mg per kilogram of body weight per day for children. People with reduced kidney function should not receive more than 2.5 mg per kg body weight per day. The total daily dose is usually increased to a maximum of 5 mg per kilogram in adults, or 6 mg per kilogram in children. Treatment should be stopped if no improvement is seen within 3 months of starting treatment.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

Swallow the capsules whole with some fluid. The oral solution should be diluted with a small amount of orange or apple juice, stirred, then swallowed immediately. Use a small amount of the juice to rinse the cup, stir, and swallow the contents again, to ensure the entire dose is taken.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store cyclosporine capsules and solution at room temperature and protect from direct light. Keep the capsules in their original package until you are ready to take your dose. Once the solution has been opened, it must be used within 2 months. It should not be stored below 20°C for a long period of time because a jelly-like formation may occur. If minor flakes or slight sediments are seen, the effectiveness and safety of the product and dosing will remain accurate.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Some medications can affect vitamin and nutrient levels in the body. Below is a list of nutrient depletions associated with this medication. Talk to your doctor or pharmacist about whether taking a supplement is recommended or if you have any questions or concerns.

Neoral may deplete magnesium

How can this nutrient deficiency affect me?Magnesium is a nutrient important to the body's metabolism, energy production, and detoxification. It also is involved in the production of some hormones as well as healthy bones and teeth. Magnesium helps to control blood pressure and maintain heart health.

What can I do about this? Talk to your pharmacist about magnesium deficiency. Magnesium is available in supplement form. Before starting any nutrient supplement, always talk with your pharmacist first.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Cancer: Cyclosporine reduces the number of cells that fight infection in the body (white blood cells). This may increase your risk of developing infections and cancer, especially those of the skin and lymphoid tissue.

People with psoriasis may be at increased risk of developing skin cancer as a result of previous psoriasis treatments. While you are taking cyclosporine, it is important to limit your exposure to the sun and use appropriate sun protection such as sunscreen and protective clothing. Your doctor will monitor you for skin cancer while you are taking this medication. Talk to your doctor if you have any concerns.

Dental health: It is particularly important to maintain good dental hygiene while taking this medication, and to see a dentist regularly for teeth cleaning.

High blood pressure: This medication may cause high blood pressure. Your doctor should monitor your blood pressure regularly while you are taking this medication.

High cholesterol: This medication may increase cholesterol. Your doctor should monitor the amount of cholesterol in your blood regularly while you are taking cyclosporine.

Infection: Cyclosporine works by reducing the number of white blood cells in the body, making it easier to develop an infection. If possible, avoid contact with people who have contagious infections. Tell your doctor immediately if you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney function: Cyclosporine can have harmful effects on the kidney when it is taken for long periods of time. If you experience signs of decreased kidney function, such as reduced urine production; fluid build-up; or swelling in the ankles, feet and hands; fatigue; or abdominal pain, contact your doctor as soon as possible.

If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People taking cyclosporine may have changes in liver function that produce abnormal liver test results. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Your doctor will likely recommend regular liver tests while you are taking this medication. If you have severe changes in liver function, your doctor may recommend that you take a lower dose of this medication or stop taking it altogether.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Potassium levels: Cyclosporine increases the risk of high levels of potassium in your body, especially for people who have decreased kidney function. Your doctor will monitor the amount of potassium in your blood with blood tests. If you experience unexplained nausea, fatigue, muscle weakness or tingling sensations, contact your doctor, as these may be signs of too much potassium.

Vaccines: People taking cyclosporine may not respond as well to vaccines or may be at risk of becoming ill from a live vaccine. Talk to your doctor if you need any vaccinations while taking this medication.

Pregnancy: This medication should be used during pregnancy only if the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Do not stop taking this medication without guidance from your doctor.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking cyclosporine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Many studies have shown that children require higher doses per kilogram of body weight than adults. It is not recommended for children for the treatment of psoriasis or rheumatoid arthritis.

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.